Performance of references based on body mass index for detecting excess body fatness in schoolchildren aged 7 to10 years

Objective: To compare the sensitivity and specificity of body mass index (BMI)-based classification systems and to determine the optimal cut-offs for predicting excess body fatness in schoolchildren. Methods: 2795 schoolchildren aged 7 - 10 years were examined. Excess body fatness was defined as the standardized residuals of the sum of three skinfold thickness ranking at or above the 90th percentile. The international BMI-based system recommended by the World Health Organization (WHO-2007) was evaluated on the basis of its sensitivity and specificity for detecting excess body fatness and compared with a national BMI reference (Brazil-2006). Likelihood ratios analysis was used to select the optimal cut-offs in each curve. Results: The two classification systems presented high sensitivity (92.5 - 98.6%) and moderate specificity (75.9 - 85.0%) for both sexes. The optimal BMI cut-offs improved specificity with no marked loss of sensitivity. Using the proposed BMI cut-offs, the post-test probability of predicting excess body fatness for children classified as non-overweight decreased from 10 (pre-test probability) to 1.4% in girls and to 1.1% in boys. For overweight children, this probability increased to more than 46.0%. Conclusion: The results showed that both the WHO-2007 and Brazil-2006 classification systems can be used as screening instruments for excess body fatness, and that one of the limitations of using the BMI-for-age references could be improved by refining the existing cut-offs